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APPLICATIC- 1 FOR CONSTRUCT'lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: i]GAS ❑ELECTRIC J —� <br /> 259-8810 <br /> 'J DEMOLITION L] COMBINATION �✓'BUILDING L i MECHANICAL ❑ PLUMBING fJ SIGN <br /> OWNER MAILADDRESS CITV :IP PNONE <br /> ,e/�Y.�/a�/D AN�E-�E,+� /5i�� �AKcS �=✓E.e�iT l�r�ri 252 3y�4/ <br /> TENANT MAILADDRES$ CITY 21P PHONE <br /> ` / Lc<1Rf1�n �I��cTT >��O/ - <br /> AFCHITECTORDESIGNEfl MFILAO�RESS CITY Z�p PMONE <br /> /�v,dr/r-�: 2ron 7 �/Z (�n�-$1 �dC,C'� iT `��'�_n/ 15Z_ Z�,S•3 <br /> GENERALCONTRFCTOR MAILADOPESS CITY ZIP PHONE STATELICENSEp <br /> aru,ri�� <br /> MECNFNICALCONTRACTOR MAILAODRESS CITY ZIP PHONE STATLIiCENSEa <br /> PLUMBING CONTRACTOR Mpl!qDDRE55 CITY ZIP PNONE STATE LICENSE a <br /> CONTRACTPRICEOFWORK �Z <br /> L <br /> OESCRIBE W09K AND SOUARE �^ CONTACT PERSON ANO PNONE NO. <br /> G�[�i✓S .L'.LGL>� �nL/I L E/>GN T CYA.0 G�t_ <br /> /�,� s.asu, rrc n I_�.vs 1/i�To,2 /�ii/D��s�c��� �3S - 92.57 <br /> ���// G-C �Z'x� 'G � i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THI5 <br /> PROPOSEO USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGA�DESCRIPTIONCFPROPERTV�SHOWNBELOWOR�TTFCHTWOCOPIES� WORK WILL BE COMPLETF.D WITH WHETHER SPECIFIED HEREIN OR <br /> �or a�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> N�J — �,� — A� AUTHORITY TO VIOL�TE OR CANCEL THE PROVISIONS OF ANY <br /> ,�� f OTHER STATE OA LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORM1IANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �72 JO.S- ,2 - OSG�- ODO� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTA%I.O.NUMBEP APPLICATION IS MAGE AND I COMPLY Wll"H THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRIICTION LOAN LENDER.AD�RESS,TELEPHONE NUMBER <br /> /// o,� � n - ,=e� �7�,�.�'� ,�,.,.,.;,� I -- 3- 1 - y 4- <br /> PROJECT ADDRESS scnkfuac <br /> ni[ <br /> UiV BUSiNESS 4CEN5[NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVA?ORY(WASH BASIN) _ � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLGTHES DRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATIO�d FAN � <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE ; <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> ORINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP , <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS--RAINLEADERS � EXHAUST FAN <br /> _ SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> � <br /> � <br /> � <br /> SUB TOTAL 5 ; SUB TOTAL F � <br /> PERMIT $ � PERMIT $ ; <br /> TOTAL FEE 3 ; TOTAL FEE S � <br /> FOR OFFICE USE ONLY: � <br /> FRONTSETBAGN REARSEiB SIDESETBFCK � F�ANCHEC: NUMBER fEE ECEIPTNO. <br /> �' S�' �B �3- <5' p y `�? 9,�� <br /> USEZONE LOTAREA VACANTSITE FEES ` VALUATION FEE <br /> ,� -L ❑ YES ❑ NO T- <br /> BUILDING ��� <br /> i <br /> iYPEOFCONST NO.O STORIES ccCUvavtr NoorOwFluncuHrts <br /> _ cao-a ( PLUMBING � <br /> � <br /> SIZEO BLDG. PIRESPRINKLERSREO'D EASEMENT MECHANICAL i <br /> ❑ YES ! NO <br /> O ; <br /> OGCUPANCVLOA� FIqEALA AREO'0 HEIGHTLIMITATION ADDITIONALPLANCHECK i <br /> � 'Vu �/ � G�HER <br /> REFSGI� <br /> -T_ <br /> STATE BUILDING SURCHARGE � � <br /> INTANE BY PLANS�pV�D BY � <br /> [� CITY OF EVERETT PUBLIC WORKS .1— <br /> v LOCALSALES ' <br /> onrE � c1 TAX COOE IS 3105 Torn� �5� <br /> � <br />